The Centers for Medicare & Medicaid Services' (CMS's) proposed rule containing revisions to the Medicare Physician Fee Schedule for 2019, released on July 12, proposed a simplified payment system for patient evaluation and management (E/M) services. The proposal would replace the existing five Medicare reimbursement levels for both new and existing patient visits with a single payment rate for each.
Reimbursement for new patient visits, which currently range from
$76 for a level 2 visit to $211 for a level 5 visit, would be
replaced with a single $135 rate. Visits with established patients,
which are currently reimbursed at $22 for a level 2 visit and up to
$148 for a level 5 visit, would all be paid at $93 per visit under
the proposal. Reimbursement for level 1 visits, for nonphysician
services, would remain unchanged. Levels 2 through 5 reflect
increasingly complex levels of care.
Some industry participants have expressed concern that physicians
who treat a disproportionate number of patients with complex needs
will be undercompensated if the changes go into effect. Recognizing
this issue, CMS has provided in the proposal for additional
payments for prolonged visits ($67 per additional half-hour) and a
$14 add-on payment for many specialist services.
Comments on the proposal are due by September 10. If finalized, the changes would become effective in January 2019.
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